Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC

Facility

$15,010.52

Service Code	MSDRG 147
Min. Negotiated Rate	$10,185.71
Max. Negotiated Rate	$15,010.52
Rate for Payer: Anthem Medicaid	$10,185.71
Rate for Payer: Anthem Medicare Advantage/PPO	$10,721.80
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,010.52
Rate for Payer: CareSource Just4Me Medicare	$14,474.43
Rate for Payer: Humana KY Medicaid	$10,185.71
Rate for Payer: Humana Medicare Advantage	$10,721.80
Rate for Payer: Kentucky WC Medicaid	$10,287.57
Rate for Payer: Molina Healthcare Benefit Exchange	$12,866.16
Rate for Payer: Molina Healthcare Medicaid	$10,389.42

MS-DRG 42.00: EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC

Facility

$27,663.57

Service Code	MSDRG 146
Min. Negotiated Rate	$18,771.71
Max. Negotiated Rate	$27,663.57
Rate for Payer: Anthem Medicaid	$18,771.71
Rate for Payer: Anthem Medicare Advantage/PPO	$19,759.69
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$27,663.57
Rate for Payer: CareSource Just4Me Medicare	$26,675.58
Rate for Payer: Humana KY Medicaid	$18,771.71
Rate for Payer: Humana Medicare Advantage	$19,759.69
Rate for Payer: Kentucky WC Medicaid	$18,959.42
Rate for Payer: Molina Healthcare Benefit Exchange	$23,711.63
Rate for Payer: Molina Healthcare Medicaid	$19,147.14

MS-DRG 42.00: EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC

Facility

$9,655.31

Service Code	MSDRG 148
Min. Negotiated Rate	$6,551.82
Max. Negotiated Rate	$9,655.31
Rate for Payer: Anthem Medicaid	$6,551.82
Rate for Payer: Anthem Medicare Advantage/PPO	$6,896.65
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,655.31
Rate for Payer: CareSource Just4Me Medicare	$9,310.48
Rate for Payer: Humana KY Medicaid	$6,551.82
Rate for Payer: Humana Medicare Advantage	$6,896.65
Rate for Payer: Kentucky WC Medicaid	$6,617.34
Rate for Payer: Molina Healthcare Benefit Exchange	$8,275.98
Rate for Payer: Molina Healthcare Medicaid	$6,682.85

MS-DRG 42.00: ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES

Facility

$258,434.40

Service Code	MSDRG 003
Min. Negotiated Rate	$175,366.20
Max. Negotiated Rate	$258,434.40
Rate for Payer: Anthem Medicaid	$175,366.20
Rate for Payer: Anthem Medicare Advantage/PPO	$184,596.00
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$258,434.40
Rate for Payer: CareSource Just4Me Medicare	$249,204.60
Rate for Payer: Humana KY Medicaid	$175,366.20
Rate for Payer: Humana Medicare Advantage	$184,596.00
Rate for Payer: Kentucky WC Medicaid	$177,119.86
Rate for Payer: Molina Healthcare Benefit Exchange	$221,515.20
Rate for Payer: Molina Healthcare Medicaid	$178,873.52

MS-DRG 42.00: ENDOCRINE DISORDERS WITH CC

Facility

$12,461.33

Service Code	MSDRG 644
Min. Negotiated Rate	$8,455.90
Max. Negotiated Rate	$12,461.33
Rate for Payer: Anthem Medicaid	$8,455.90
Rate for Payer: Anthem Medicare Advantage/PPO	$8,900.95
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$12,461.33
Rate for Payer: CareSource Just4Me Medicare	$12,016.28
Rate for Payer: Humana KY Medicaid	$8,455.90
Rate for Payer: Humana Medicare Advantage	$8,900.95
Rate for Payer: Kentucky WC Medicaid	$8,540.46
Rate for Payer: Molina Healthcare Benefit Exchange	$10,681.14
Rate for Payer: Molina Healthcare Medicaid	$8,625.02

MS-DRG 42.00: ENDOCRINE DISORDERS WITH MCC

Facility

$19,984.66

Service Code	MSDRG 643
Min. Negotiated Rate	$13,561.02
Max. Negotiated Rate	$19,984.66
Rate for Payer: Anthem Medicaid	$13,561.02
Rate for Payer: Anthem Medicare Advantage/PPO	$14,274.76
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$19,984.66
Rate for Payer: CareSource Just4Me Medicare	$19,270.93
Rate for Payer: Humana KY Medicaid	$13,561.02
Rate for Payer: Humana Medicare Advantage	$14,274.76
Rate for Payer: Kentucky WC Medicaid	$13,696.63
Rate for Payer: Molina Healthcare Benefit Exchange	$17,129.71
Rate for Payer: Molina Healthcare Medicaid	$13,832.24

MS-DRG 42.00: ENDOCRINE DISORDERS WITHOUT CC/MCC

Facility

$9,390.01

Service Code	MSDRG 645
Min. Negotiated Rate	$6,371.79
Max. Negotiated Rate	$9,390.01
Rate for Payer: Anthem Medicaid	$6,371.79
Rate for Payer: Anthem Medicare Advantage/PPO	$6,707.15
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,390.01
Rate for Payer: CareSource Just4Me Medicare	$9,054.65
Rate for Payer: Humana KY Medicaid	$6,371.79
Rate for Payer: Humana Medicare Advantage	$6,707.15
Rate for Payer: Kentucky WC Medicaid	$6,435.51
Rate for Payer: Molina Healthcare Benefit Exchange	$8,048.58
Rate for Payer: Molina Healthcare Medicaid	$6,499.23

MS-DRG 42.00: ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC

Facility

$72,240.46

Service Code	MSDRG 266
Min. Negotiated Rate	$49,020.31
Max. Negotiated Rate	$72,240.46
Rate for Payer: Anthem Medicaid	$49,020.31
Rate for Payer: Anthem Medicare Advantage/PPO	$51,600.33
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$72,240.46
Rate for Payer: CareSource Just4Me Medicare	$69,660.45
Rate for Payer: Humana KY Medicaid	$49,020.31
Rate for Payer: Humana Medicare Advantage	$51,600.33
Rate for Payer: Kentucky WC Medicaid	$49,510.52
Rate for Payer: Molina Healthcare Benefit Exchange	$61,920.40
Rate for Payer: Molina Healthcare Medicaid	$50,000.72

MS-DRG 42.00: ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC

Facility

$56,731.92

Service Code	MSDRG 267
Min. Negotiated Rate	$38,496.66
Max. Negotiated Rate	$56,731.92
Rate for Payer: Anthem Medicaid	$38,496.66
Rate for Payer: Anthem Medicare Advantage/PPO	$40,522.80
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$56,731.92
Rate for Payer: CareSource Just4Me Medicare	$54,705.78
Rate for Payer: Humana KY Medicaid	$38,496.66
Rate for Payer: Humana Medicare Advantage	$40,522.80
Rate for Payer: Kentucky WC Medicaid	$38,881.63
Rate for Payer: Molina Healthcare Benefit Exchange	$48,627.36
Rate for Payer: Molina Healthcare Medicaid	$39,266.59

MS-DRG 42.00: EPISTAXIS WITH MCC

Facility

$16,667.34

Service Code	MSDRG 150
Min. Negotiated Rate	$11,309.98
Max. Negotiated Rate	$16,667.34
Rate for Payer: Anthem Medicaid	$11,309.98
Rate for Payer: Anthem Medicare Advantage/PPO	$11,905.24
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$16,667.34
Rate for Payer: CareSource Just4Me Medicare	$16,072.07
Rate for Payer: Humana KY Medicaid	$11,309.98
Rate for Payer: Humana Medicare Advantage	$11,905.24
Rate for Payer: Kentucky WC Medicaid	$11,423.08
Rate for Payer: Molina Healthcare Benefit Exchange	$14,286.29
Rate for Payer: Molina Healthcare Medicaid	$11,536.18

MS-DRG 42.00: EPISTAXIS WITHOUT MCC

Facility

$9,140.40

Service Code	MSDRG 151
Min. Negotiated Rate	$6,202.42
Max. Negotiated Rate	$9,140.40
Rate for Payer: Anthem Medicaid	$6,202.42
Rate for Payer: Anthem Medicare Advantage/PPO	$6,528.86
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,140.40
Rate for Payer: CareSource Just4Me Medicare	$8,813.96
Rate for Payer: Humana KY Medicaid	$6,202.42
Rate for Payer: Humana Medicare Advantage	$6,528.86
Rate for Payer: Kentucky WC Medicaid	$6,264.44
Rate for Payer: Molina Healthcare Benefit Exchange	$7,834.63
Rate for Payer: Molina Healthcare Medicaid	$6,326.47

MS-DRG 42.00: ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC

Facility

$15,489.22

Service Code	MSDRG 391
Min. Negotiated Rate	$10,510.54
Max. Negotiated Rate	$15,489.22
Rate for Payer: Anthem Medicaid	$10,510.54
Rate for Payer: Anthem Medicare Advantage/PPO	$11,063.73
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,489.22
Rate for Payer: CareSource Just4Me Medicare	$14,936.04
Rate for Payer: Humana KY Medicaid	$10,510.54
Rate for Payer: Humana Medicare Advantage	$11,063.73
Rate for Payer: Kentucky WC Medicaid	$10,615.65
Rate for Payer: Molina Healthcare Benefit Exchange	$13,276.48
Rate for Payer: Molina Healthcare Medicaid	$10,720.75

MS-DRG 42.00: ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC

Facility

$9,409.29

Service Code	MSDRG 392
Min. Negotiated Rate	$6,384.87
Max. Negotiated Rate	$9,409.29
Rate for Payer: Anthem Medicaid	$6,384.87
Rate for Payer: Anthem Medicare Advantage/PPO	$6,720.92
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,409.29
Rate for Payer: CareSource Just4Me Medicare	$9,073.24
Rate for Payer: Humana KY Medicaid	$6,384.87
Rate for Payer: Humana Medicare Advantage	$6,720.92
Rate for Payer: Kentucky WC Medicaid	$6,448.72
Rate for Payer: Molina Healthcare Benefit Exchange	$8,065.10
Rate for Payer: Molina Healthcare Medicaid	$6,512.57

MS-DRG 42.00: EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT

Facility

$52,176.24

Service Code	MSDRG 933
Min. Negotiated Rate	$35,405.30
Max. Negotiated Rate	$52,176.24
Rate for Payer: Anthem Medicaid	$35,405.30
Rate for Payer: Anthem Medicare Advantage/PPO	$37,268.74
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$52,176.24
Rate for Payer: CareSource Just4Me Medicare	$50,312.80
Rate for Payer: Humana KY Medicaid	$35,405.30
Rate for Payer: Humana Medicare Advantage	$37,268.74
Rate for Payer: Kentucky WC Medicaid	$35,759.36
Rate for Payer: Molina Healthcare Benefit Exchange	$44,722.49
Rate for Payer: Molina Healthcare Medicaid	$36,113.41

MS-DRG 42.00: EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT

Facility

$286,062.99

Service Code	MSDRG 927
Min. Negotiated Rate	$194,114.17
Max. Negotiated Rate	$286,062.99
Rate for Payer: Anthem Medicaid	$194,114.17
Rate for Payer: Anthem Medicare Advantage/PPO	$204,330.71
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$286,062.99
Rate for Payer: CareSource Just4Me Medicare	$275,846.46
Rate for Payer: Humana KY Medicaid	$194,114.17
Rate for Payer: Humana Medicare Advantage	$204,330.71
Rate for Payer: Kentucky WC Medicaid	$196,055.32
Rate for Payer: Molina Healthcare Benefit Exchange	$245,196.85
Rate for Payer: Molina Healthcare Medicaid	$197,996.46

MS-DRG 42.00: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$29,522.99

Service Code	MSDRG 982
Min. Negotiated Rate	$20,033.46
Max. Negotiated Rate	$29,522.99
Rate for Payer: Anthem Medicaid	$20,033.46
Rate for Payer: Anthem Medicare Advantage/PPO	$21,087.85
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$29,522.99
Rate for Payer: CareSource Just4Me Medicare	$28,468.60
Rate for Payer: Humana KY Medicaid	$20,033.46
Rate for Payer: Humana Medicare Advantage	$21,087.85
Rate for Payer: Kentucky WC Medicaid	$20,233.79
Rate for Payer: Molina Healthcare Benefit Exchange	$25,305.42
Rate for Payer: Molina Healthcare Medicaid	$20,434.13

MS-DRG 42.00: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$57,325.23

Service Code	MSDRG 981
Min. Negotiated Rate	$38,899.26
Max. Negotiated Rate	$57,325.23
Rate for Payer: Anthem Medicaid	$38,899.26
Rate for Payer: Anthem Medicare Advantage/PPO	$40,946.59
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$57,325.23
Rate for Payer: CareSource Just4Me Medicare	$55,277.90
Rate for Payer: Humana KY Medicaid	$38,899.26
Rate for Payer: Humana Medicare Advantage	$40,946.59
Rate for Payer: Kentucky WC Medicaid	$39,288.25
Rate for Payer: Molina Healthcare Benefit Exchange	$49,135.91
Rate for Payer: Molina Healthcare Medicaid	$39,677.25

MS-DRG 42.00: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$20,116.10

Service Code	MSDRG 983
Min. Negotiated Rate	$13,650.21
Max. Negotiated Rate	$20,116.10
Rate for Payer: Anthem Medicaid	$13,650.21
Rate for Payer: Anthem Medicare Advantage/PPO	$14,368.64
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$20,116.10
Rate for Payer: CareSource Just4Me Medicare	$19,397.66
Rate for Payer: Humana KY Medicaid	$13,650.21
Rate for Payer: Humana Medicare Advantage	$14,368.64
Rate for Payer: Kentucky WC Medicaid	$13,786.71
Rate for Payer: Molina Healthcare Benefit Exchange	$17,242.37
Rate for Payer: Molina Healthcare Medicaid	$13,923.21

MS-DRG 42.00: EXTRACRANIAL PROCEDURES WITH CC

Facility

$19,429.96

Service Code	MSDRG 038
Min. Negotiated Rate	$13,184.61
Max. Negotiated Rate	$19,429.96
Rate for Payer: Anthem Medicaid	$13,184.61
Rate for Payer: Anthem Medicare Advantage/PPO	$13,878.54
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$19,429.96
Rate for Payer: CareSource Just4Me Medicare	$18,736.03
Rate for Payer: Humana KY Medicaid	$13,184.61
Rate for Payer: Humana Medicare Advantage	$13,878.54
Rate for Payer: Kentucky WC Medicaid	$13,316.46
Rate for Payer: Molina Healthcare Benefit Exchange	$16,654.25
Rate for Payer: Molina Healthcare Medicaid	$13,448.31

MS-DRG 42.00: EXTRACRANIAL PROCEDURES WITH MCC

Facility

$40,045.31

Service Code	MSDRG 037
Min. Negotiated Rate	$27,173.60
Max. Negotiated Rate	$40,045.31
Rate for Payer: Anthem Medicaid	$27,173.60
Rate for Payer: Anthem Medicare Advantage/PPO	$28,603.79
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$40,045.31
Rate for Payer: CareSource Just4Me Medicare	$38,615.12
Rate for Payer: Humana KY Medicaid	$27,173.60
Rate for Payer: Humana Medicare Advantage	$28,603.79
Rate for Payer: Kentucky WC Medicaid	$27,445.34
Rate for Payer: Molina Healthcare Benefit Exchange	$34,324.55
Rate for Payer: Molina Healthcare Medicaid	$27,717.07

MS-DRG 42.00: EXTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

$13,725.05

Service Code	MSDRG 039
Min. Negotiated Rate	$9,313.43
Max. Negotiated Rate	$13,725.05
Rate for Payer: Anthem Medicaid	$9,313.43
Rate for Payer: Anthem Medicare Advantage/PPO	$9,803.61
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$13,725.05
Rate for Payer: CareSource Just4Me Medicare	$13,234.87
Rate for Payer: Humana KY Medicaid	$9,313.43
Rate for Payer: Humana Medicare Advantage	$9,803.61
Rate for Payer: Kentucky WC Medicaid	$9,406.56
Rate for Payer: Molina Healthcare Benefit Exchange	$11,764.33
Rate for Payer: Molina Healthcare Medicaid	$9,499.70

MS-DRG 42.00: EXTRAOCULAR PROCEDURES EXCEPT ORBIT

Facility

$18,461.69

Service Code	MSDRG 115
Min. Negotiated Rate	$12,527.57
Max. Negotiated Rate	$18,461.69
Rate for Payer: Anthem Medicaid	$12,527.57
Rate for Payer: Anthem Medicare Advantage/PPO	$13,186.92
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$18,461.69
Rate for Payer: CareSource Just4Me Medicare	$17,802.34
Rate for Payer: Humana KY Medicaid	$12,527.57
Rate for Payer: Humana Medicare Advantage	$13,186.92
Rate for Payer: Kentucky WC Medicaid	$12,652.85
Rate for Payer: Molina Healthcare Benefit Exchange	$15,824.30
Rate for Payer: Molina Healthcare Medicaid	$12,778.13

MS-DRG 42.00: EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE

Facility

$71,685.75

Service Code	MSDRG 790
Min. Negotiated Rate	$48,643.90
Max. Negotiated Rate	$71,685.75
Rate for Payer: Anthem Medicaid	$48,643.90
Rate for Payer: Anthem Medicare Advantage/PPO	$51,204.11
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$71,685.75
Rate for Payer: CareSource Just4Me Medicare	$69,125.55
Rate for Payer: Humana KY Medicaid	$48,643.90
Rate for Payer: Humana Medicare Advantage	$51,204.11
Rate for Payer: Kentucky WC Medicaid	$49,130.34
Rate for Payer: Molina Healthcare Benefit Exchange	$61,444.93
Rate for Payer: Molina Healthcare Medicaid	$49,616.78

MS-DRG 42.00: FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

$16,427.40

Service Code	MSDRG 748
Min. Negotiated Rate	$11,147.17
Max. Negotiated Rate	$16,427.40
Rate for Payer: Anthem Medicaid	$11,147.17
Rate for Payer: Anthem Medicare Advantage/PPO	$11,733.86
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$16,427.40
Rate for Payer: CareSource Just4Me Medicare	$15,840.71
Rate for Payer: Humana KY Medicaid	$11,147.17
Rate for Payer: Humana Medicare Advantage	$11,733.86
Rate for Payer: Kentucky WC Medicaid	$11,258.64
Rate for Payer: Molina Healthcare Benefit Exchange	$14,080.63
Rate for Payer: Molina Healthcare Medicaid	$11,370.11

MS-DRG 42.00: FEVER AND INFLAMMATORY CONDITIONS

Facility

$10,828.57

Service Code	MSDRG 864
Min. Negotiated Rate	$7,347.96
Max. Negotiated Rate	$10,828.57
Rate for Payer: Anthem Medicaid	$7,347.96
Rate for Payer: Anthem Medicare Advantage/PPO	$7,734.69
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,828.57
Rate for Payer: CareSource Just4Me Medicare	$10,441.83
Rate for Payer: Humana KY Medicaid	$7,347.96
Rate for Payer: Humana Medicare Advantage	$7,734.69
Rate for Payer: Kentucky WC Medicaid	$7,421.44
Rate for Payer: Molina Healthcare Benefit Exchange	$9,281.63
Rate for Payer: Molina Healthcare Medicaid	$7,494.91

Know your out-of-pocket cost for care.

All Charges